Introduction The Albumin-Bilirubin (ALBI) grade, has been recently proposed for assessing liver function in patients with hepatocellular carcinoma (HCC) showing good performance in predicting survival after liver resection (LR) and loco-regional therapy. We aimed to evaluate the impact of post operative change in ALBI to predict decompensation and survival after LR for HCC.
Method Consecutive patients undergoing resection for HCC between 2011–2014 at the Royal Free Hospital were evaluated. Demographic, clinical data and histopathological features of resected tumour were collected. Patients underwent HVPG and ICG clearance measurement to evaluate potential resectability. ALBI score was calculated pre-LR and 1 week post- LR. Patients were divided into 3 categories (ALBI 1,2,3) according to published ALBI score cut-offs. Cox regression was used to identify predictors of decompensation and survival post LR.
Results 66 patients were included with a median post LR follow up of 16 months (0.25–61): male 58 (88%), mean age 63 years (28-83). Median HVPG 6 mmHg (1-15), median ICG PDR 18.4 (6.0–35), median ICG R15 6.4 (0.5–32.5). 64 (97%) of patients had a Child Pugh score A5. 63 (95.5%) had a pre-LR ALBI grade 1 and 3 (4.5%) had an ALBI grade 2. Clinically significant portal hypertension (HVPG ≥10 mmHg) was found in 13 (19.7%) patients. Thirteen (19.7%) patients had an ICG PDR <15, while 7 (10.6%) had ICG R15>15. Forty-three (65.2%) patients underwent an anatomical resection, while 23 (34.8%) had a wedge resection. Post-LR decompensation was observed in 6 (9%) patients: ascites n=5, encephalopathy n=1 at a median of 9 days post-LR. 17 (26%) patients had HCC recurrence after a median time of 8 months (3-60). 10 (15%) died after a median follow up of 14.5 months (0.25–39), 5 of them due to tumour recurrence. 2 patients with pre-LR ALBI grade 2 died after 7 and 11 months due to HCC recurrence and decompensated cirrhosis, respectively. At 1 week post-LR 96.6% of patients showed a worsening of ALBI score, shifting from ALBI grade 1 to 2 and 3. Among patients with 1 week post-LR ALBI grade 3 (n=14), 50% of them died within 2 years from surgery compared to 7% of ALBI grade 1–2 (p<0.001). Kaplan Meier analysis showed that ALBI grade 3 at 1 week post LR was significantly associated with mortality.
Conclusion Change in ALBI grade at 1 week predicts survival in patients undergoing LR for HCC
Disclosure of Interest None Declared
- Hepatocellular carcinoma